The whole point of free speech is not to make ideas exempt from criticism but to expose them to it.

Tuesday, August 25, 2009

Some telling stats.


Anonymous said...

Above is an article comparing birthweight-specific infant mortality for native Americans compared with whites, six states, 1980.

Here is a more recent study.

Two points. The nations we are compared with have a much more honogeneous population than we do. If you factor that in, it does change the stats.

Secondly, the Native Americans have a much higher incidence of infant mortality, and they are under a gov't run health care system. And that is supposed to be good for the rest of us then??

Les said...

Bringing broadband to rural America, we are constantly compared to countries roughly the size of some of our states. The claims are how much better and more deeply distributed their systems are. We have few customers per square mile compared to their thousands per square mile. The distorted figures should not excuse us in the mental and physical well being of our native families we have colonized. This should become a major part of the health care battle as well.

Neal said...

Bill, don't you think these stats probably have more to do with lifestyle choices than healthcare?

betty76 said...

neal - so are you saying germans are making better 'lifestyle choices' than us? does that mean they smarter than us?

if that's the case, maybe we ahould do what they do.

anonymous - (second question)

of course when we have obstructionists in our government who want certain programs to fail, they won't work. how could they?

i think the problem isn't the system, it's the foot-draggers who want the system to collapse.

Bill Fleming said...

Anonymous says: "The nations we are compared with have a much more honogeneous population than we do. If you factor that in, it does change the stats."

First, how do you factor that in? And second, what does it change the stats to?

It wouldn't surprise me to learn that you can get about any numbers you want if you start leaving people out.

Neal said...

Betty asked,
"neal - so are you saying germans are making better 'lifestyle choices' than us?"

Yes, absolutely. Look no further than obesity rates:

US: 30%
Germany: 13%
Japan: 3%

"if that's the case, maybe we should do what they do."

If you mean make better choices about diet, exercise, and lifestyle, I agree wholeheartedly.

If you mean institute universal healthcare, I'm not so sure.

About the last thing I want is to be responsible for providing healthcare to people whose poor health is directly related to poor lifestyle decisions.

Plus there's the moral hazard problem: what incentive do people have to make better lifestyle choices if they know that no matter what consequences may come from those decisions, their trip to the doctor will only require a $30 co-pay?

Taunia Adams said...

Neal writes: "Plus there's the moral hazard problem: what incentive do people have to make better lifestyle choices if they know that no matter what consequences may come from those decisions, their trip to the doctor will only require a $30 co-pay?"

Yeah, that's one I've never heard of.

If you have no morals, and you're fat, you are not entitled to healthcare?

WTF is wrong with the state of thinking today?

Neal said...

Taunia, I'm not sure if you understand what I mean by moral hazard. It has nothing to do with morals:

"Moral hazard is the prospect that a party insulated from risk may behave differently from the way it would behave if it were fully exposed to the risk."

The risk here is costs associated with healthcare. The hazard is that people who bear no burden with respect to healthcare costs will behave with less regard for their health (and accordingly the costs associated with their healthcare).

And yes, I'd be more inclined to share my resources (in the form of universal healthcare) with someone whose lifestyle choices indicate at least a modicum of interest in their own health.

Do you wish to respond to the substance of that point, or will it be strictly ad hominem? Just wonderin'.

Bill Fleming said...

Neal, think your position through, man. You either want everyone to have health care or you don't. Equal protection, remember?

Neal said...

Why is it everyone's first reaction to suggest that any disagreement is the result of insufficient or poor thought? Do you and Taunia see the implicit insult there?

I want everyone to have healthcare, Bill, just like I want world peace. But I have doubts about whether or not it's actually obtainable in this country. Americans are a different breed. We take more risks, drive bigger and faster cars, and eat more supersized value meals, with the 64oz pop.

Many of our health problems are self-induced. Americans in particular (compared to our international counterparts) live lives that are especially risky in terms of health. And I'm not just talking about obesity, although that is certainly a factor.

Universal healthcare will create, for some people, a government subsidy for poor lifestyle decisions. This is a moral hazard -- one that I'm not sure I want to take.

Moreover, the costs associated with providing universal healthcare in a nation such as ours will be monumental. In that light, Bob's point is valid -- universal healthcare may bankrupt us.

Is anyone going to respond to the substance of these questions? Or should I just expect more personal attacks? If the latter, I'll keep my thoughts to myself.

Bill Fleming said...

I think we have responded to the substance, Neal. I think everyone here is quite fond of you. I certainly am. I just question your suggestion that we all have to conform to a certain lifestyle in order to receive a social benefit. Would you hold this same standard for Social Security for example? Do you require it now of the members in your group health policy?

This is not to say that I don't understand what you're saying. I just think it's a separate issue.

Taunia Adams said...

Call me dense. Call me slow. Call me thick. Whatever.

My idea remains the same after reading Neal's (higher up) post and his following responses.

According to Neal, if you're fat, lazy, (and now American), you don't deserve healthcare.

The exact opposite is true. If you drink, don't you NEED AA? If you do drugs don't you NEED a dryout center? If you have a mental problem don't you NEED some mental health facility?

If you're overweight, sluggish and AMERICAN, wouldn't you NEED healthcare?

I somehow feel like I'm getting set up here.

Les said...

Not sure this post doesn't appear a little too controlled for me Bill. Neal's point being discussed is no farther from substance on health care than your stats? MHO. Where does the cost of ones actions depart a responsible society? And another of someones good questions Bill, is equal health care a guaranteed right? I do not recall hearing an answer.

Bill Fleming said...

It's a Constitutional right for prisoners, Les. To deny it would be considered cruel and unusual punishment.

It's a right guaranteed to seniors via medicare and medicaid, and very few citizens I know are arguing that it should be abolished.

I'll let you put it together from there.

If it's not currently a right, my position is that it should be made one. Regardless of lifestyle.

Or, as Taunia suggests, perhaps even because of lifestyle, or at a minimum, life circumstances.

Neal said...

Taunia said,
"I somehow feel like I'm getting set up here."

And I feel as if it's not in my better judgment to continue to discuss this with you, when you first insult me and then misrepresent me.

But I will, because this seems out of character for you. Have I struck a nerve? If so, it was not intentional.

"According to Neal, if you're fat, lazy, (and now American), you don't deserve healthcare."

This is an outright misrepresentation. I never said this.

What I did is voice my concerns. I'm wrestling with this issue, trying to determine where I stand. I offered my views here in a good-faith attempt to get some sort of substantive dialogue -- to help me better understand myself, and my position on universal healthcare. Unfortunately, neither you nor Bill has been willing to cooperate.

Thus, my concerns about moral hazard remain unabated.

I agree, Taunia, that alcoholics need AA, etc. And without reservation I support using tax revenues (my money) to pay for such things, or for smoking cessation efforts, and the like.

But at what point do people have to take responsibility for their actions, and for their decisions? If a guy smokes cigarettes for 30 years, is it really my obligation to pay for his chemotherapy when -- surprise! -- he comes down with lung cancer?



Bill Fleming said...

Not sure what Taunia will say, Neal, but my first questions to you are, do you have a health insurance plan now? Do you pay the premiums, or does your employer pay them as part of your employment benefits package? Once you answer those questions, maybe I'll have a little better insight as to where you're coming from with your question. Thanks.

Neal said...

I'm reluctant to answer those questions, Bill, because they are irrelevant. The concerns I've voiced here have nothing to do with whether or not I personally have health insurance.

I've told you all you need to know about where I'm coming from.

I'm not trying to dodge anything. If you can explain why you need answers to those questions before you answer mine, I'll share.

For now, I will say that I have lived a significant portion of my life WITHOUT health insurance.

I'll also say that I don't smoke, I don't drink (except on rare occasions), I am not obese, and I don't drive a motorcycle. (The 4 riskiest things I can think of right now.)

Bill Fleming said...

Ok, got it, Neal. Now I think perhaps I understand your question a little better.

If you pay taxes, I'm assuming you pay FICA taxes as well as income taxes. That's where your Medicare benefits will come from some day. By far the greatest amount the average person spends on health care is at the end of life.

Medicare is a government subsidized form of Health Insurance. So in essence, if you're paying in to FICA, you're paying for other people's health care now, regardless of how they lived their lives.

Those that lived the "healthiest" lifestyle will theoretically live the longest, thus using up a lot more of "your" tax money than would say an unhealthy person who was only on Medicare for a few years before they died. Do you see how that works?

Whether you're paying FICA taxes or paying a private insurance company, you're still paying premiums into a health care plan. If you're healthy, you'll almost always be in a situation where the money you spend on Health Care protection will go to paying the health care costs of someone less healthy than you are.

The only way out of it for you would be some kind of Medical Savings Account that you fund with your own money. Is that what you'd prefer? You'll still have to pay FICA taxes though, most likely, or rather, perhaps I should say most people will, since you seem not to want this to get too personal.

Anyway, the long and short if it is that the times in a lifetime of greatest health care expenditure are at the beginnings and the ends of it. And by far, the greatest amount is spent at the end. By far. That's why we have Medicare.

Ok, questions. Does that help?

Neal said...

I don't mean to be snide, but no, that doesn't really help.

I understand how things currently work with medicare etc., and I'm not terribly interested in talking about repealing medicare. It's just not anywhere on the political radar.

What we're talking about here -- at least what I'm trying to talk about -- is whether or not we should expand the concepts we currently employ via medicare to the general population -- universal healthcare.

I realize that I'm currently paying for the hypothetical smoker's chemo, if he happens to be old enough to qualify for medicare when he is diagnosed. I get that. Whether it's right or wrong I think is beside the point.

What I want to know with these issues I've raised is, why should this concept be expanded to cover not just the old, but everyone?

Do you see the distinction I'm trying to make there? Just because I already pay for the smoker's chemo in some circumstances does not necessarily mean I should have to pay for it in every circumstance.

I don't need to argue for the repeal of medicare to properly raise these issues.

Bill Fleming said...

Well we're halfway there, Neal.

First, what I'm understanding about the proposal is that your decision to use Medicare as your primary health care plan would be OPTIONAL. If you want to insure yourself some other way, via private insurance, you can.

And second, if you do go the private route, chances are your premiums will still be going to pay someone else's health care costs (or to try to avoid having to pay them) or to pay insurance company executives and stockholders. I think something like 80% of private insurance premiums go to health care, the rest to profit, conflict dispute, and administrative.

Those numbers are quite different with Medicare currently and would presumably stay that way, with more like 93% of the money going to health care.

So, unless you completely self-fund...

Anyway, on to "wellness." What you might be talking about is a reduced premium or wellness credits or something? Kind of like now with health and life insurance. Smokers have to pay more for coverage for example. Scuba divers and skydivers have to pay through the nose, etc. You're aware of all that, right? Do I hear you saying you want the best possible price for your insurance because you have a healthy lifestyle and are risk averse? If so, that seems reasonable.

What doesn't seem reasonable is for you to expect to provide universal coverage only to those who are willing to commit to a healthy diet and lifestyle.

But that's not really what you're saying, is it? ...or is it?

So where are we. You don't have to buy the alternative form of coverage, whatever it's going to be... extended Medicare, some new kind of co-op thing, whatever they come up with to compete with private insurance as it is now... you can totally self insure if you want to, or you can keep the plan you have now.

So now are we getting anywhere?

Bill Fleming said...

One more overarching point, Neal. The whole idea is to get people who can't get coverage now, covered. This includes people with pre-existing conditions, some perhaps due to poor lifestyle choices, some just bad luck or genetic circumstances, whatever.

Also, make the coverage portable so you don't have to lose your coverage when you change jobs, or move to a different state, etc.

And finally, to bring the costs down by increasing both competition and efficiency.

Those are the key points aren't they?

On some other threads we looked at some possible fixes. I think you linked us to the Atlantic article didn't you? And there was the idea outlined in the WSJ. Did you like any of those ideas?

Les said...

Bill, the question was equal healthcare. I do not believe our pisoners get equal health care. Maybe I am wrong on that, but I've yet to see any at the Cancer Institute of America. Please define equal health care for me. With Blue Cross ins, I don't believe I get the same care as a homeless person walking into Rapid Regional since I live 35 miles from the nearest rural hospital which cannot compare to RCR as a provider.

Taunia Adams said...

Neal, et al

I didn't realize this thread was still open. It's way down on the list.

I'm sure we'll carry this discussion on to newer posts. See ya at the next!

Neal said...

Yes, Bill, we're getting somewhere.

You said,
"Do I hear you saying you want the best possible price for your insurance because you have a healthy lifestyle and are risk averse?"

What I'm saying is that I'd be more inclined to support the idea of universal healthcare if personal responsibility remains a viable component -- if somehow people were rewarded for making healthy lifestyle decisions and/or punished for making poor lifestyle decisions.

I'm going to restate my ultimate question in the thread above.